Comparison of Rotational with Orbital Atherectomy During Percutaneous Coronary Intervention for Coronary Artery Calcification: A Systematic Review and Meta-Analysis

Sawant, Abhishek C.; Panchal, Hemang B.; Radadiya, Dhruvil; Pomakov, Alexander; Tse, Gary; Liu, Tong; Sridhara, Srilekha; Rodriguez, Janelle; Prakash, Meghana Prakash Hiriyur; Kanwar, Nidhi; Kumar, Arnav; Banerjee, Kinjal; Wiesner, Philipp; Pershad, Ashish

doi:10.1016/j.carrev.2019.07.019

Cited by 8 publications

(3 citation statements)

References 20 publications

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“…Our results show that although there were no significant difference in MACE, MI, all‐cause mortality, OA was associated with lower long‐term MACE, short‐term MI and long‐term TVR compared to RA. Recently, a meta‐analysis by Sawant et al 19 reported a statistically significant difference in MACE and mortality favoring OA compared to RA. Peri‐procedural MI and vascular complications were not different between OA and RA groups.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of rotational atherectomy versus orbital atherectomy for the treatment of heavily calcified coronary stenosis: A systematic review and meta‐analysis

Khan

Murtaza

Khalid

et al. 2020

Cathet Cardio Intervent

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Introduction The optimal approach to deal with severe coronary artery calcification (CAC) during percutaneous coronary intervention (PCI) remains ill‐defined. Methods We conducted an electronic database search of all published studies comparing Orbital versus Rotational Atherectomy in patients undergoing PCI. Results Eight observational studies were included in the analysis. Overall, there were no significant differences in Major‐adverse‐cardiac‐events/MACE (OR: 0.81, CI: 0.63–1.05, p = .11), myocardial‐infarction/MI (OR: 0.75, CI: 0.56–1.00, p = .05), all‐cause mortality (OR: 0.82, CI: 0.25–2.64, p = .73) or Target‐vessel‐revascularization/TVR (OR: 0.72, CI: 0.38–1.36, p = .31). However, OA was associated with lower long‐term MACE (1‐year), (OR: 0.66, CI: 0.44–0.99, p = .04), long‐term TVR (OR: 0.40, CI: 0.18–0.89, p = .03), and short‐term MI (in‐hospital and 30‐day) (OR: 0.64, CI: 0.44–0.94, p = .02). OA was associated with more coronary artery dissections (OR: 2.61, CI: 1.38–4.92, p = .003) and device‐related coronary perforations (OR: 2.79, CI: 1.08–7.19, p = .03). There were no differences in cardiac tamponade (OR: 1.78, CI: 0.37–8.69, p = .47). OA was noted to have significantly lower fluoroscopy time (MD: −3.96 min, CI: −7.67, −0.25; p = .04) compared to RA. No significant difference was noted in terms of contrast volume between the two groups (OR: −4.35 ml, CI: −14.52, 23.22; p = .65). Conclusion Although there was no difference in overall MACE, MI, all‐cause mortality and TVR, OA was associated with lower long‐term MACE and short‐term MI. OA is associated with lower fluoroscopy time but higher rates of coronary artery dissection and coronary perforation.

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Section: Discussionmentioning

confidence: 99%

Outcomes of rotational atherectomy versus orbital atherectomy for the treatment of heavily calcified coronary stenosis: A systematic review and meta‐analysis

Khan

Murtaza

Khalid

et al. 2020

Cathet Cardio Intervent

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“…Four such studies have indicated no clinical benefit to RA compared to OA, 16,17,19,31 and one suggested reduction in fluoroscopy time, MI, and mortality at hospital discharge with OA compared with RA 18 . A meta‐analysis summarizing four of the aforementioned observational studies found an increased odds ratio of major adverse cardiac events (MACE) with RA compared to OA, 32 however this analysis was weighed heavily by the results of a single study 19 with cohorts that were not propensity matched. The present analysis expands on these findings, demonstrating statistically similar rates of post‐procedural complications with the two atherectomy modalities.…”

Section: Discussionmentioning

confidence: 99%

Comparison of rotational and orbital atherectomy for the treatment of calcific coronary lesions: Insights from the VA clinical assessment reporting and tracking (CART) program

Barrett

Warsavage

Kovach

et al. 2020

Cathet Cardio Intervent

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Background Previous studies suggested that pre‐treatment of coronary artery calcification (CAC) with rotational atherectomy (RA) prior to stent deployment improved procedural success but was not associated with a concomitant improvement in clinical outcomes. Orbital atherectomy (OA) has demonstrated similar benefits, though there are few data comparing the safety and efficacy of the two modalities. Methods Patients who underwent PCI of a native coronary lesion with RA or OA from 2014 to 2018 within the Veterans Affairs Healthcare System were identified. Propensity matched cohorts were generated to compare the clinical and safety outcomes following either RA or OA. The primary endpoint was the rate of 30‐day major adverse cardiovascular and cerebrovascular events (MACCE), including all‐cause mortality, repeat myocardial infarction, target vessel revascularization, and stroke. Results We identified 1,091 patients that underwent atherectomy during the study period, 640 (59%) treated with RA and 451 (41%) treated with OA. Among a propensity‐matched cohort consisting of 950 patients, there was no significant difference in MACCE for patients who underwent RA or OA (7.1 vs. 8.2%, p = .36). Components of the primary outcome including 30‐day mortality, myocardial infarction, target vessel revascularization, and stroke were also similar in the matched cohort. Additionally, procedural complications including perforation, no‐reflow, dissection, and in‐stent thrombosis were comparable across both treatment strategies. Conclusions Both rotational and orbital atherectomy are safe and effective strategies for the treatment of calcified coronary plaque prior to stent deployment, with similarly low rates of peri‐procedural adverse events.

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“…A systematic review and meta-analysis comparing OA and RA yielded similar results [ 79 ]. At this time the choice between which device to use should be based on user preference and institutional availability.…”

Section: Calcified Lesionsmentioning

confidence: 85%

Defining Key Features of Complex Coronary Lesions: An Evidence Based Review of Clinical Practice. Part I: Bifurcations, Left Main Disease, and Calcifications

Feldman¹,

Beerkens²,

Nicolas³

et al. 2022

Rev. Cardiovasc. Med.

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Clinicians have long recognized that certain features of coronary artery lesions increase the complexity of intervention. Complex lesions are associated with worse cardiovascular outcomes and a higher risk of subsequent ischemic events. These lesions are categorized by their angiographic features. These features include bifurcation lesions, left main coronary artery disease, calcified lesions, in-stent restenosis, chronic total occlusions and graft interventions. This two-part review aims to highlight the current evidence in the percutaneous management of these lesions. Part one of this review focuses on the best techniques to treat bifurcation lesions, indications for intervention of left main coronary artery disease and additional tools used to treat calcified lesions.

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Comparison of Rotational with Orbital Atherectomy During Percutaneous Coronary Intervention for Coronary Artery Calcification: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 20 publications

Outcomes of rotational atherectomy versus orbital atherectomy for the treatment of heavily calcified coronary stenosis: A systematic review and meta‐analysis

Outcomes of rotational atherectomy versus orbital atherectomy for the treatment of heavily calcified coronary stenosis: A systematic review and meta‐analysis

Comparison of rotational and orbital atherectomy for the treatment of calcific coronary lesions: Insights from the VA clinical assessment reporting and tracking (CART) program

Defining Key Features of Complex Coronary Lesions: An Evidence Based Review of Clinical Practice. Part I: Bifurcations, Left Main Disease, and Calcifications

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